TOP 12 - From Milestones to Mastery: A SMART Goal Framework for Feedback in Neonatal-Perinatal Fellowship Training

Publication Number: 3740.TOP 12

Meghan V. Handley, University of Virginia School of Medicine, Gordonsville, VA, United States; Movicque King, University of Virginia, Louisa, VA, United States; Alix Paget-Brown, UVA Childrens, Charlottesville, VA, United States; Sarah Miller, UVA Childrens, Charlottesville, VA, United States; Jennifer Burnsed, University of Virginia School of Medicine, Charlottesville, VA, United States; Jaclyn Wiggins, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: Delivering and receiving high-quality feedback within the high-acuity environment of the neonatal intensive care unit (NICU) is inherently challenging. Recognizing this barrier, our fellowship program implemented a structured feedback tool to promote more frequent and deliberate feedback exchanges. The “feedback cards” guided fellows to articulate two individualized learning goals before each service week, enabled faculty to suggest an additional goal, and provided a space for contemporaneous written feedback. While the intervention improved the quantity of feedback interactions, preliminary review of the written goals revealed limited specificity and measurability, suggesting inconsistent application of SMART (Specific, Measurable, Achievable, Relevant, Time-bound) principles. The current phase of this project focuses on improving goal quality and exploring how fellows’ written goals reflect progression within the ACGME Milestones 2.0 framework.

Objective: To explore how a structured feedback intervention influences the quality and content of NICU fellows’ written learning goals, using inductive and deductive qualitative coding to evaluate adherence to SMART criteria and alignment with ACGME Milestones 2.0.

Design/Methods: We are conducting a qualitative analysis of NICU fellows’ written learning goals before and after implementation of a structured feedback workshop designed to improve SMART goal formulation with ACGME milestone 2.0 alignment. 174 unique pre-intervention written goals from the feedback cards were de-identified and analyzed using both inductive and deductive coding. Deductive codes reflected predefined SMART criteria and ACGME Milestones 2.0 competencies, while inductive codes identified emergent themes regarding fellows’ goal-setting practices. Two investigators independently coded each goal and compared with artificial intelligence codes. Overall, 3% of written goals met all SMART criteria. The feedback workgroup will meet to resolve discrepancies, and compare with specific and tailored milestones, as well as to develop ideas for future interventions to continue to improve the feedback between fellows and faculty at our institution.